Primary Tuberculosis Following Exposure

November 2007

Case History

A twenty year old woman was evaluated as a contact of a patient who had extensive smear positive pulmonary tuberculosis (drug susceptible isolate). She denied any symptoms of cough, weight loss, fatigue, night sweats or fever. She weighed 86 pounds. A TST was positive with a 20 mm induration. A chest x-ray (CXR) showed opacification of the lower half of the left hemithorax reflective of a moderate size left pleural effusion and/or atelectasis. She had normal laboratory values. She was not able to provide a sputum specimen.

Four months prior to the contact investigation, she delivered a healthy infant. An evaluation during the 20th week of gestation noted her weight at 100 pounds; the patient reported her normal, non-pregnant weight at 98 pounds. Her child had not yet been evaluated as a contact but was reported as "healthy".

This patient emigrated from the Marshall Islands to the United States in 2001. She denied any exposure to tuberculosis prior to this contact investigation. She had a TST placed during her prenatal care with a reading of 0 mm induration.

Further evaluation included induced sputums which were AFB smear negative but grew M. tuberculosis susceptible to all first line drugs. A CT scan revealed hilar adenopathy, volume loss, pleural thickening and a moderate pleural effusion on the left, and patchy infiltrates in the right middle and right upper lobe. A repeat CXR done on the same date as the CT scan was interpreted as a normal chest.

The infant had a normal physical exam and CXR. The TST was 0 mm.

Teaching Points

References

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Kreider, M.E. and Rossman, M.D. "Pulmonary Tuberculosis" in Tuberculosis and Nontuberculous Mycobacterial Infections, Fifth Edition. Schlossberg, D, editor. McGraw-Hill, Medical Publishing Division. 2006. p. 177-187

Kreiswirth, G.E.; Burzynski, J.; and Schluger, N.W. Clinical and Radiographic Correlates of Primary and Reactivation Tuberculosis: A Molecular Epidemiology Study. JAMA. June 8, 2005. Volume 203(22), pp. 2740-2745.

Shao, C.; Qu, J. and He, L. A Comparative Study of Clinical Manifestations Caused by Tuberculosis in Immunocompromised and Non-immunocompromised Patients. Chinese Medical Journal (English). November 2003. Volume 116(11), pp. 1717-1722.

Starke, J. "Tuberculosis in Infants and Children" in Tuberculosis and Nontuberculous Mycobacterial Infections, Fifth Edition. Schlossberg, D, editor. McGraw-Hill, Medical Publishing Division. 2006. p. 372-373.

Heartland National TB Center
2303 SE Military Drive
San Antonio, Texas 78223
Phone: 1 (800) TEX-LUNG
Fax: (210) 531-4590
http://www.heartlandntbc.org/